Benign symmetric lipomatosis with tongue involvement in a non-alcoholic woman: Case report and literature review

Benign symmetric lipomatosis (BSL, Madelung's disease) is a rare disorder characterized by symmetric, non-encapsulated adipose tissue proliferation, typically of the neck and upper trunk. Tongue involvement is exceptionally rare and can present as progressive fatty macroglossia with significant functional impairment. We report the case of a 63-year-old woman with progressive macroglossia causing dysphagia, dysarthria, and dyspnea. Magnetic resonance imaging revealed diffuse fatty infiltration of the tongue. The histopathological examination revealed benign adipose infiltration. Treatment comprised tongue volume reduction via partial glossectomy combined with intramuscular lipectomy. At the one-year follow-up, the patient showed marked functional improvement in swallowing, speech, and breathing, with no clinical recurrence. This case highlights the need to include BSL in the differential diagnosis of acquired fatty macroglossia and supports conservative surgical reduction to restore function in affected patients.